Healthcare Provider Details

I. General information

NPI: 1538167218
Provider Name (Legal Business Name): TED ALLAN SCHNEIDER MA, CSW, LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S OLD WOODWARD AVE STE 212A
BIRMINGHAM MI
48009-6117
US

IV. Provider business mailing address

300 E MAPLE RD STE 320
BIRMINGHAM MI
48009-6308
US

V. Phone/Fax

Practice location:
  • Phone: 248-644-2900
  • Fax: 248-644-2902
Mailing address:
  • Phone: 248-644-2900
  • Fax: 248-644-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301002954
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801820618
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: